Li Chunbo, Wang Hong, Liu Haifei, Yin Jingbo, Cui Lei, Chen Zenggan
Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Feng Lin Road No. 180, XuHui District, Shanghai, 200032, People's Republic of China.
Eur Spine J. 2014 Nov;23(11):2423-31. doi: 10.1007/s00586-014-3438-0. Epub 2014 Jul 8.
Spinal epidural fibrosis and adhesion are implicated as one of the key factors of failed back surgery syndrome, which may cause dura mater compression or peridural tethering, resulting in persistent backache and leg pain. Various materials or drugs have been used to inhibit formation of epidural fibrosis and reduce the compressive effect on neural structures. Nevertheless, the effects are not satisfied. In this study, we investigated the prevention effect of poly (L-glutamic acid)/chitosan (PLGA/CS) barrier on epidural fibrosis developing post-laminectomy in a rabbit model.
Sixteen rabbits were divided randomly into two equal groups: group A (experimental group, n = 8) and group B (non-treatment group, n = 8). In both groups, total L5-6 laminectomy was performed; further both ligamentum flavum and epidural fat were removed gently. In experimental group, the laminectomy sites were treated with PLGA/CS barriers, while no additional treatment was received in non-treatment group. At 1, 12 and 24 weeks post-surgery, the animals were subjected to magnetic resonance imaging (MRI) evaluation. Following last MRI examination, all rabbits were sacrificed and their spinal columns were totally removed for further macroscopic and histological evaluation.
MRI showed that rabbits treated with PLGA/CS barrier at 12 and 24 weeks post-surgery had less epidural fibrosis or scar tissue, peridural adhesion, foreign body reaction and low pressure of spinal cord in comparison with the non-treatment group. In consistence with the radiographic results, macroscopic analysis and histological examination showed that the amount of scar tissue and the extent of epidural adhesion decreased significantly in experimental groups. Concerning the fibroblast density evaluated, the scores were significantly lower in experimental group compared with those in non-treatment group.
The results of our study demonstrate that PLGA/CS barrier is effective in inhibiting epidural fibrosis and peridural adhesions in post-laminectomy rabbit model.
脊柱硬膜外纤维化和粘连被认为是腰椎手术失败综合征的关键因素之一，可导致硬脊膜受压或硬膜外束带形成，引起持续的背痛和腿痛。人们已使用多种材料或药物来抑制硬膜外纤维化的形成并减轻对神经结构的压迫作用。然而，效果并不理想。在本研究中，我们在兔模型中研究了聚（L-谷氨酸）/壳聚糖（PLGA/CS）屏障对椎板切除术后硬膜外纤维化形成的预防作用。
将16只兔子随机分为两组，每组8只：A组（实验组）和B组（未治疗组）。两组均行L5-6全椎板切除术，同时轻柔地去除黄韧带和硬膜外脂肪。实验组在椎板切除部位用PLGA/CS屏障处理，未治疗组不接受额外处理。术后1、12和24周，对动物进行磁共振成像（MRI）评估。在最后一次MRI检查后，处死所有兔子并完整取出其脊柱进行进一步的大体和组织学评估。
MRI显示，与未治疗组相比，术后12周和24周接受PLGA/CS屏障治疗的兔子硬膜外纤维化或瘢痕组织、硬膜外粘连、异物反应较少，脊髓压力较低。与影像学结果一致，大体分析和组织学检查显示实验组瘢痕组织量和硬膜外粘连程度明显降低。就评估的成纤维细胞密度而言，实验组的评分明显低于未治疗组。
我们的研究结果表明，PLGA/CS屏障在抑制兔椎板切除术后硬膜外纤维化和硬膜外粘连方面是有效的。
